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The Case for an Accessory Branch of the Superficial Peroneal Nerve
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The Case for an Accessory Branch of the Superficial Peroneal Nerve
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Tony Morris
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 has been demonstrated by diagnostic injection providing major onset of relief from pain and major functional improvement. A small amount of that functional improvement has been maintained days later, however, the pain and sensory symptoms restored a few hours after the effects of the injection subsided.
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Although a motor deficit is not normally possible with such a distal mononeuropathy, there are reported cases of an accessory branch of the superficial peroneal nerve providing additional nerve supply to the extensor digitorum brevis. Such an anomaly can provide an explanation that an entrapment of the superficial peroneal nerve can result in denervation of the extensor digitorum brevis muscle and can cause functional loss.
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It has been shown by both Electromyograph and MRI studies that there is denervation in the extensor digitorum brevis muscle.
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The case will be made in summary form by providing citations of the prevalence of the existence of this anatomical anomaly, explaining the findings of EMG and MRI studies and the functional improvement immediately following a diagnostic injection.
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 Volume 209, Number 2 / June, 1975
\par {\pntext }
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}\pard \pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls3 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls3 {\pntext }
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}
{\f3 \b0 \fs20 \cf1 \i1 
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ISSN
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 0340-5354
\par {\pntext }
}
}
}\pard 
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The innervation of the right M. extensor digitorum brevis was investigated in 52 subjects with the aid of stimulation electromyography. In 13 cases (25%) a particular branch of the superficial branch of the peroneal nerve, the accessory deep peroneal nerve, could be identified. In 1 case it alone, and in 12 cases, together with the deep peroneal nerve, innervated the M. ext. dig. brevis. The significance of the awareness of this anomalous innervation is pointed out.
\par 
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}
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{\li960 \f3 \qj \b0 \ri0 \fs20 \cf1 \i0 
{\*\bkmkstart id2942232}{\*\bkmkend id2942232}
\par 
{\li960 \f3 \qj \b0 \ri0 \fs20 \cf1 \i0 
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Journal of Anatomy
\par 
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}
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}
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{\li960 \f4 \qj \b0 \ri0 \fs20 \cf1 \i0 
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The consistent presence of the human accessory deep peroneal nerve
\par 
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}
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}\pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls4 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls4 {\pntext }
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Publisher
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 Cambridge University Press
\par {\pntext }
}
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}\pard \pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls5 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls5 {\pntext }
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}
{\f3 \b0 \fs20 \cf1 \i1 
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Issue
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 01 - January 1999
\par {\pntext }
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}\pard 
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Twenty-four human legs were dissected macroscopically to study the morphological details of the accessory deep peroneal nerve. 
}
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[continues]
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 The accessory deep peroneal nerve was found in every case examined and constantly gave off muscular branches to peroneus brevis and sensory branches to the ankle region. In addition, this nerve occasionally had muscular branches to peroneus longus and extensor digitorum brevis, and sensory branches to the fibula and the foot.
\par 
}
}
}
}
}
{\li960 \f3 \qj \b0 \ri0 \fs20 \cf1 \i0 
{\*\bkmkstart id2943227}{\*\bkmkend id2943227}
\par 
{\li960 \f3 \qj \b0 \ri0 \fs20 \cf1 \i0 
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Examination of peripheral nerve injuries: an anatomical approach
\par 
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}
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}
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}\pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls6 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls6 {\pntext }
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}
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Author
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 Stephen M. Russell
\par {\pntext }
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}
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Publisher
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 Thieme Publishers
\par {\pntext }
}
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}\pard \pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls8 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls8 {\pntext }
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}
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Edition
}
}
{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 1 - October 2006
\par {\pntext }
}
}
}\pard \pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls9 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls9 {\pntext }
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}
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ISBN
}
}
{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 1588904830
\par {\pntext }
}
}
}\pard 
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{\f3 \strike0 \ul0 \b0 \sa200 \sb200 \fs20 \cf1 \i0 
The accessory peroneal nerve is a distal branch of the superficial peroneal nerve that is present in approximately 20% of people. This branch carries motor innervation to the extensor digitorum brevis, a muscle that is usually controlled by the deep peroneal nerve.
\par 
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}
}
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}
{\li960 \f3 \qj \b0 \ri0 \fs20 \cf1 \i0 
{\*\bkmkstart id2943296}{\*\bkmkend id2943296}
\par 
{\li960 \f3 \qj \b0 \ri0 \fs20 \cf1 \i0 
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Journal of Neurology, Neurosurgery & Psychiatry
\par 
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{\li960 \f4 \qj \b0 \ri0 \fs20 \cf1 \i0 
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Hereditary aspects of accessory deep peroneal nerve
\par 
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}
}
}\pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls10 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls10 {\pntext }
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}
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Publisher
}
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 BMJ Publishing Group
\par {\pntext }
}
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}\pard \pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls11 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls11 {\pntext }
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}
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Issue
}
}
{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 36 - 1973
\par {\pntext }
}
}
}\pard \pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls12 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls12 {\pntext }
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}
{\f3 \b0 \fs20 \cf1 \i1 
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ISSN
}
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 0022-3050
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}\pard 
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Hereditary aspects in the anomalous innervation of the extensor digitorum brevis muscle by the accessory deep peroneal nerve, were investigated. Utilizing electrophysiological techniques, 22% of 100 healthy unrelated individuals demonstrated this variation in innervation of one or both extensor digitorum brevis muscles.
\par 
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}
}
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}
{\li960 \f3 \qj \b0 \ri0 \fs20 \cf1 \i0 
{\*\bkmkstart id2943359}{\*\bkmkend id2943359}
\par 
{\li960 \f3 \qj \b0 \ri0 \fs20 \cf1 \i0 
{\li960 \f3 \qj \b0 \ri0 \fs20 \cf1 \i0 
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Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice
\par 
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Author
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 Jun Kimura M.D.
\par {\pntext }
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Publisher
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 Oxford University Press
\par {\pntext }
}
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}\pard \pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls15 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls15 {\pntext }
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}
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Edition
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}
{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 3 - 2001
\par {\pntext }
}
}
}\pard \pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls16 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls16 {\pntext }
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}
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ISBN
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 0195129776
\par {\pntext }
}
}
}\pard 
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
The most frequent anomaly of the lower limb involves the innervation of the extensor digitorum brevis, the muscle commonly used in conduction studies of the peroneal nerve. This muscle usually derives its supply from the deep peroneal nerve, a major branch of the common peroneal nerve. In 20-28% of an unselected population, the superficial peroneal nerve also contributes via a communicating fiber. This branch, called the accessory deep peroneal nerve, descends on the lateral aspect of the leg after arising from the superficial peroneal nerve, 
}
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[continues]
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\par 
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This anomaly when inherited, shows a dominant trait.
\par 
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}
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{\*\bkmkstart id2941774}{\*\bkmkend id2941774}
\par 
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Clinical Electromyography: Nerve Conduction Studies
\par 
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}
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Author
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 Shin J. Oh
\par {\pntext }
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Publisher
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 Lippincott Williams & Wilkins
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}
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Edition
}
}
{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 3 - 2002
\par {\pntext }
}
}
}\pard \pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls20 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls20 {\pntext }
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}
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ISBN
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{\f3 \strike0 \ul0 \b0 \sa0 \sb0 \fs20 \cf1 \i0 
 0781736811
\par {\pntext }
}
}
}\pard 
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The accessory deep peroneal nerve is a common variant of the common peroneal nerve innervating the extensor digitorum brevis (EDB). The EDB is usually innervated exclusively by the deep peroneal nerve, a main branch of the common peroneal nerve. However, in 19% to 22% of persons, one or both of the EDBs are innervated partially by the accessory deep peroneal nerve, a branch of the superficial peroneal nerve.
\par 
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}
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{\*\bkmkstart id2941846}{\*\bkmkend id2941846}
\par 
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Pubmed
\par 
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Accessory deep peroneal nerve - a clinically significant anomaly?
\par 
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Owsiak S, Kostera-Pruszczyk A, Rowinska-Marcinska K.
\par {\pntext }
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}\pard \pard \fi-360 \li {\*\pn \pnlvlblt \ilvl0 \ls22 \pnindent960 \pnf1 {\f2 \pntxtb \u8226\'3f}}\ls22 {\pntext }
{\li1160 \f3 \qj \b0 \ri0 \fs20 \cf1 \i0 
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}
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Publisher
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 BMJ Publishing Group
\par {\pntext }
}
}
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}
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Issue
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 2008
\par {\pntext }
}
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The accessory deep peroneal nerve (ADPN), a variant of the peroneal nerve, may give motor branches to the extensor digitorum brevis muscle (EDB) in 19-28% of the general population and in up to 78% of subjects in familial cases. The aim of our study was to evaluate its significance in the examination of the peroneal nerve.
\par 
}
}
}
}
}
}
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{\*\bkmkstart Bibliography}{\*\bkmkend Bibliography}
\par 
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Bibliography
\par 
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}
}
}
}
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{\*\bkmkstart CaseForSPN}{\*\bkmkend CaseForSPN}
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[CaseForSPN] 
}
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 Tony Morris . 
}
}
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 2009 . 
}
}
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{\f3 \b0 \fs20 \cf1 \i1 
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}
{\field {\*\fldinst HYPERLINK "url(http://spn.tmorris.net/)" }{\fldrslt 
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The Case for Entrapment Neuropathy of Superficial Peroneal Nerve Entrapment
}}}
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 [
}
{\field {\*\fldinst HYPERLINK "url(http://spn.tmorris.net/)" }{\fldrslt 
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http://spn.tmorris.net/
}}}
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]
}
}
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}
}
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. 
\par 
}
}
}\sect }